Recommendation Planned
developments
Timing Lead agency Outcomes
6.1 Enhanced domiciliary care – Commissioners will assess the evidence of national initiatives on specialisation to review the model of domiciliary care in the county, to shape future commissioning.
2010 ASSD
6.2 Improve community based crisis response services specifically for older people with mental health problems, including dementia, including stronger integration with universal crisis response and out of hours services, to provide a 24/7 service with jointly developed,
negotiated and agreed comprehensive local protocols for mental health
referrals Review of models for CRHT including IST in Central Norfolk Work on integrating health and social care out of hours services
Commissioner and NWMHFT
Commissioners
6.3 As part of the planed work on the integrated pathway explore options for closer integration between specialist health and social care services and new roles Workshops on developing pathways and service models during consultation period Initially complete by February 2010 Commissioners
Recommendation Planned developments
Timing Lead agency Outcomes
6.4 Day opportunities Agree a joint health and social care model for more flexible day opportunities which will support joint commissioning and the expansion of services to meet needs.
Development of model of day opportunities/day treatment, new specification for dementia day care
2009/10 ASSD and both PCTS
6.5 Advocacy services – We will develop an advocacy strategy that takes account of the gaps in current provision, and also takes account of the enhanced awareness and rights arising from the Mental Capacity Act
Joint
commissioning of IMCA and IMHA service
End of March 2010 ASSD with both PCTs
Potential Quality indicators (EOE guidance)
• Record numbers of people using day services
• Record numbers of new referrals to day services
• Record numbers of people accessing day treatment and associated services during crisis
• CSC Annual service user and family carer satisfaction survey on the accessibility, responsiveness and quality of service provided. Surveys should be conducted independently of the service provider and an annual report submitted to the commissioning organisation detailing an action plan for service improvement
• Annual report to commissioning organisations of the numbers of complaints and SUIs received, detailing an action plan for service improvement
• Target date for CRHT to be available to anyone over the age of 18 years.
• Reduction in overall bed occupancy and lengths of stay for older people following the commencement of CRHT, in accordance with DH expectations. Achieving this reduction can be measured by comparing the numbers of admissions, and lengths of stay, in the two years prior to the CRHT commencing with the present year
• CRHT team to record the numbers of admissions that had been notified to, and seen by, the CRHT service prior to admission
• Annual service user and family carer satisfaction survey on the accessibility, responsiveness and quality of service provided. Surveys should be conducted independently of the service provider and an annual report submitted to the commissioning organisation detailing an action plan for service improvement
• Annual report to commissioning organisations of the numbers of complaints and SUIs received, detailing an action plan for service improvement
• A reduction in the number of people going in to long term residential care over a five year period
• Record the number of people with dementia who are offered, and uptake, personal budgets
Where are we now and priorities for change
National Dementia Strategy Objective 7: Carers – the most valuable support for people with dementia
Family carers are the most important support available for people with dementia. Active work is needed to ensure the provisions of the Carers’ Strategy are available for carers of people with dementia. Carers have a right to an assessment of their need and support through an agreed plan to
maintain the important role they play in the care of the person with dementia. This will include good quality personalised breaks. Action should also be taken to strengthen support for children who are in caring roles, ensuring that their particular needs as children are protected. It is especially important to recognise and support the need for carers to have a life of their own, as carers of people with dementia are more likely to experience stress, depression and isolation.
Approximately two thirds of people living with dementia are cared for at home, the majority of that care being provided by family and friends. Supporting the family carer is crucial in enabling people with dementia to remain at home or in their choice of place to live. When working with the person with dementia, the needs of the family carer must also be taken into account. One in 5 carers providing high levels of care over 50 hours per week report that they are not in good health, a rate twice that of non carers, and carers report high levels of psychological distress.
A 2008 survey of Norfolk carers included 58 carers of people with dementia. When asked about current problems, 42% reported lack of emotional
wellbeing, 1in 4 poor health and 1 in 4 not having any life of their own. When asked what would improve their quality of life, over a third said more practical help or respite to enable them to have a life of their own and almost 1 in 5 wanted better health or emotional wellbeing. When asked which service had made the most difference to them, most carers rated some form of respite highly, whether at home, at day care or in a care home. Emotional support from the Alzheimer’s Society or other voluntary organisation was mentioned by 1 in 5.
Current situation in Norfolk
GP practices add carers to their carers register and refer onto ASSD for a carers assessment.
As well as services for all carers such as carers’ assessments, social work support, equipment etc, ASSD provides respite through specialist day centres across the county for people with dementia, as well as places in frail elderly day care and care homes. Current work on ASSD day opportunities identified the need to develop more specialist day care places for people with dementia. There are 4 housing with care respite flats and block booked beds in care homes. Crossroads provide sitting services specifically for people with dementia in their own homes. This is free to carers supported by the Carers Grant.
For people eligible for NHS continuing care, the NHS will commission support at home and respite in care homes.
Current situation in Norfolk contd
The ASSD out of hours dementia service provides help and advice out-of- hours in people’s homes or over the telephone. Emergency respite care for carers is now available for carers registered with In My Place.
Adult Education provides ‘Understanding the person with dementia’ courses aimed at carers, and works with Carers groups, offering training on dementia, reminiscence and life story work. Memory Boxes are available to borrow from Mobile Libraries.
The Alzheimer’s Society and NWMHFT offer carers a set of six weekly/ fortnightly sessions with speakers on e.g. driving, benefits. The Alzheimer’s Society provides emotional support, signposting and opportunities for support from other carers.
Age Concern Norfolk provides opportunities for breaks through Pabulum sessions and the Pabulum cafes.
The library service has set up 3 cafes for Carers of people with dementia, providing support, information and the chance to borrow a Memory Box. West Norfolk Carers and Norwich & District Carers Forum offer support to all carers in groups and individuals. Carers of people with dementia also have access to services offered to all carers through the Carers Grant for Norfolk such as Short Breaks at Short Notice run by Crossroads and the Carers Education Grant run by Age Concern Norfolk.
The Carer’s Emergency Respite service ‘In my place’ offers support when carers have an emergency which means that they cannot provide care
Norfolk priorities for action
• Ensuring that the needs of carers for people with dementia are included as the Joint Commissioning Strategy for Carers is developed and
implemented, especially with regard to a range of good respite provision and the development of services that allow carers to work, enjoy a social life or study whilst knowing that the person with dementia is appropriately supported
• Improving the recognition of the needs of carers of people with dementia and the value of their role in supporting people with dementia.
• Promoting the development of breaks that benefit people with dementia as well as their carers and which offer a personalised service.
• Ensuring that carers of people with dementia have access to timely and appropriate information and support that recognise changes in need.
• Ensuring that the needs of carers are considered in assessment and care planning in the community and in hospital.
• Ensuring that professionals are aware of the resources available to support carers.
• Ensure that carers have access to personal budgets
• Carers are supported to recognise and manage their own health needs
• Improving the involvement of carers in service design and development.